Provider Demographics
NPI:1760633465
Name:BERRIOS COLON, JAN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ANTONIO
Last Name:BERRIOS COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:701 S HOWARD AVE
Mailing Address - Street 2:SUITE 106-116
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2473
Mailing Address - Country:US
Mailing Address - Phone:813-250-0611
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:620 10TH ST N
Practice Address - Street 2:SUITE 2E
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8325
Practice Address - Fax:727-824-8347
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO521YMedicare PIN
FLDO521ZMedicare PIN